Methods for placing an implant analog in a physical model of the patient&#39;s mouth

ABSTRACT

A method of placing a dental implant analog in a physical model for use in creating a dental prosthesis is provided. The physical model, which is usually based on an impression of the patient&#39;s mouth or a scan of the patient&#39;s mouth, is prepared. The model is scanned. A three-dimensional computer model of the physical model is created and is used to develop the location of the dental implant. A robot then modifies the physical model to create an opening for the implant analog. The robot then places the implant analog within the opening at the location dictated by the three-dimensional computer model.

RELATED APPLICATIONS

This application is a continuation-in-part of pending U.S. applicationSer. No. 11/585,705 filed on Oct. 24, 2006 and entitled “Methods forManufacturing Dental Implant Components,” which claims the benefit ofU.S. Provisional Patent Application No. 60/729,506 filed on Oct. 24,2005 and entitled “Methods for Manufacturing Dental Implant Components.Both of these applications are hereby incorporated by reference in theirentireties.

FIELD OF INVENTION

The present invention relates generally to dental implant systems. Moreparticularly, the present invention relates to restoration componentsfor dental implant systems and a computer model for developing animplant analog placement tool to eliminate the need for a surgicalindex.

BACKGROUND OF THE INVENTION

The dental restoration of a partially or wholly edentulous patient withartificial dentition is typically done in two stages. In the firststage, an incision is made through the gingiva to expose the underlyingbone. An artificial tooth root, usually a dental implant, is placed inthe jawbone for integration. The dental implant generally includes athreaded bore to receive a retaining screw holding mating componentstherein. During the first stage, the gum tissue overlying the implant issutured and heals as the osseointegration process continues.

Once the osseointegration process is complete, the second stage isinitiated. Here, the gum tissue is re-opened to expose the end of thedental implant. A healing component or healing abutment is fastened tothe exposed end of the dental implant to allow the gum tissue to healtherearound. Preferably, the gum tissue heals such that the aperturethat remains generally approximates the size and contour of the aperturethat existed around the natural tooth that is being replaced. Toaccomplish this, the healing abutment attached to the exposed end of thedental implant has the same general contour as the gingival portion ofthe natural tooth being replaced.

During the typical second stage of dental restoration, the healingabutment is removed and an impression coping is fitted onto the exposedend of the implant. This allows an impression of the specific region ofthe patient's mouth to be taken so that an artificial tooth isaccurately constructed. Thus, in typical dental implant systems, thehealing component and the impression coping are two physically separatecomponents. Preferably, the impression coping has the same gingivaldimensions as the healing component so that there is no gap between theimpression coping and the wall of the gum tissue defining the aperture.Otherwise, a less than accurate impression of the condition of thepatient's mouth is made. The impression coping may be a “pick-up” typeimpression coping or a “transfer” type impression coping, both known inthe art. After these processes, a dental laboratory creates a prosthesisto be permanently secured to the dental implant from the impression thatwas made.

In addition to the method that uses the impression material and mold tomanually develop a prosthesis, systems exist that utilize scanningtechnology to assist in generating a prosthesis. A scanning device isused in one of at least three different approaches. First, a scanningdevice can scan the region in the patient's mouth where the prosthesisis to be placed without the need to use impression materials or toconstruct a mold. Second, the impression material that is removed fromthe healing abutment and surrounding area is scanned. Third, a dentistor technician can scan the stone model of the dental region that wasformed from the impression material and mold to produce the permanentcomponents.

Three basic scanning techniques exist, laser scanning, photographicimaging and mechanical sensing. Each scanning technique is used ormodified for any of the above-listed approaches (a scan of the stonemodel, a scan of the impression material, or a scan in the mouth withoutusing impression material) to create the prosthesis. After scanning, alaboratory can create and manufacture the permanent crown or bridge,usually using a computer aided design (“CAD”) package.

The utilization of a CAD program, as disclosed in U.S. Pat. No.5,338,198, (Wu), whose disclosure is incorporated by reference herein,is one method of scanning a dental region to create a three dimensionalmodel. Preferably, after the impression is made of the patient's mouth,the impression material or stone model is placed on a support tabledefining the X-Y plane. A scanning laser light probe is directed ontothe model. The laser light probe emits a pulse of laser light that isreflected by the model. A detector receives light scattered from theimpact of the beam with the impression to calculate a Z-axismeasurement. The model and the beam are relatively translated within theX-Y plane to gather a plurality of contact points with known location inthe X-Y coordinate plane. The locations of several contact points in theZ-plane are determined by detecting reflected light. Finally,correlating data of the X-Y coordinates and the Z-direction contactpoints creates a digital image. Once a pass is complete, the model maybe tilted to raise one side of the mold relative to the oppositevertically away from the X-Y plane. Subsequent to the model's secondscan, the model may be further rotated to allow for a more accuratereading of the model. After all scans are complete, the data may be fedinto a CAD system for manipulation of this electronic data by knownmeans.

Photographic imaging can also used to scan impression material, a stonemodel or to scan directly in the mouth. For example, one system takesphotographs at multiple angles in one exposure to scan a dental region,create a model and manufacture a prosthetic tooth. As disclosed in U.S.Pat. No. 5,851,115, (Carlsson), whose disclosure is incorporated byreference herein, this process is generally initiated with the processof taking a stereophotograph with a camera from approximately 50 to 150mm away from the patient's mouth. The stereophotograph can involve aphotograph of a patient's mouth already prepared with implantationdevices. Correct spatial positioning of the dental implants is obtainedby marking the implant in several locations. The resulting photographpresents multiple images of the same object. The images on thephotographs are scanned with a reading device that digitizes thephotographs to produce a digital image of the dental region. The datafrom the scanner is electronically transmitted to a graphical imagingprogram that creates a model that is displayed to the user. Afteridentification of the shape, position and other details of the model,the ultimate step is the transmission of the data to a computer formanufacturing.

A third scanning measure uses mechanical sensing. A mechanical contoursensing device, as disclosed in U.S. Pat. No. 5,652,709 (Andersson),whose disclosure is incorporated by reference herein, is another methodused to read a dental model and produce a prosthetic tooth. Theimpression model is secured to a table that may rotate about itslongitudinal axis as well as translate along the same axis with variablespeeds. A mechanical sensing unit is placed in contact with the model ata known angle and the sensing equipment is held firmly against thesurface of the model by a spring. When the model is rotated andtranslated, the sensing equipment can measure the changes in the contourand create an electronic representation of the data. A computer thenprocesses the electronic representation and the data from the scanningdevice to create a data array. The computer then compresses the data forstorage and/or transmission to the milling equipment.

When the stone model of the patient's mouth is created for use in thescanning process, or in other prior techniques, a second stone model ofthe patient's mouth is also typically used to develop a final prosthesisfor use in the patient. The prosthesis is typically developed on thesecond stone model. A surgical index is used to position the implantanalog within the second stone model so that the dental laboratory mayknow the exact position of the implant when making the prosthesis. Thesurgical index is typically a mold of the patient's teeth directlyadjacent to the implant site that relies upon the position of theadjacent teeth to dictate the location and orientation of the implantanalog within the stone model. Unfortunately, the surgical index is anadditional step in the process for the clinician that requiresadditional components. A need exists for a device and method of placingthe implant analog within the stone model without using a conventionalsurgical index.

SUMMARY OF THE INVENTION

According to one aspect of the present invention, a method of affixingan implant analog in a physical model of a patient's mouth for use increating a custom abutment comprises determining, in a three-dimensionalvirtual model of the patient's mouth, the location of the implant analogto be placed in the physical model. The method further includesdeveloping implant-analog positional information based on the locationof the implant analog in the three-dimensional virtual model anddeveloping an emergence profile contour information to provide for acontour of an opening to be made in the physical model leading to theimplant analog. The contour is preferably tapered downwardly toward theimplant analog. The method further includes transferring to a robot (i)the implant-analog positional information, and (ii) the emergenceprofile contour information, using the robot to modify the physicalmodel by creating an opening in the physical model having a taperingcontour, and using the robot to affix the implant analog within theopening of the physical model.

According to another aspect of the present invention, a method ofpositioning an implant analog in a physical model of a patient's mouthfor use in creating a custom abutment comprises scanning the physicalmodel to develop scan data of the physical model, transferring the scandata to a CAD program, and creating a three-dimensional model of atleast a portion of the physical model on the CAD program using the scandata. The method further includes determining, in the three-dimensionalmodel, the location of the implant analog to be placed in the physicalmodel, developing implant-analog positional information based on thelocation of the implant analog in the three-dimensional model, anddeveloping an emergence profile contour information to provide for acontour of an opening to be made in the physical model leading to theimplant analog. The method further includes transferring to a robot (i)the implant-analog positional information and (ii) the emergence profilecontour information, and, by use of at least one tool associated withthe robot, modifying the physical model by creating the opening. Theopening has an emergence profile corresponding to the emergence-profilecontour information. The method may further include, by use of therobot, fixing the implant analog within the opening of the physicalmodel in accordance to the implant-analog positional information.

According to yet another process of the present invention, a method ofpositioning an implant analog in a physical model of a patient's mouthfor use in creating a custom abutment, comprises scanning the physicalmodel to develop scan data of the physical model, transferring the scandata to a CAD program, and creating a three-dimensional model of atleast a portion of the physical model on the CAD program using the scandata. The method further includes determining, in the three-dimensionalmodel, the location of the implant analog to be placed in the physicalmodel, and using a robot to place an implant analog within the physicalmodel in accordance with information from the three-dimensional model.

According to yet a further aspect of the present invention, a method ofperforming guided surgery in a patient's mouth, comprises taking aCT-scan of the patient's mouth to develop CT-scan data, and developing,on a 3D-computer model, a surgical plan based on the CT-scan data. Thesurgical plan includes at least one virtual implant. The virtual implanthas virtual-implant location data and virtual implant orientation datacorresponding to a non-rotational feature on the virtual implant. Basedon the surgical plan, the method further may further includemanufacturing a surgical guide to be placed in the patient's mouth forinstalling an implant in the patient's mouth at substantially the samelocation and orientation as the virtual implant on the 3D-computermodel, and manufacturing a physical model of the patient's mouth havingan implant analog at substantially the same location and orientation asthe virtual implant on the 3D-computer model. The method furtherincludes developing a custom abutment on the physical mode, performingsurgery to place the implant in the patient's mouth as physically guidedby the surgical guide in accordance with the surgical plan, andinstalling the custom abutment on the implant.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1a is a top view of a healing abutment;

FIG. 1b is a longitudinal cross-sectional view of the healing abutmentshown in FIG. 1 a;

FIG. 1c is the healing abutment shown in FIG. 1b attached to an implant;

FIG. 2a is a top view of another embodiment of a healing abutment;

FIG. 2b is a longitudinal cross-sectional view of the healing abutmentshown in FIG. 2 a;

FIG. 3a is a top view of yet another embodiment of a healing abutment;

FIG. 3b is a longitudinal cross-sectional view of the healing abutmentshown in FIG. 3a ; and

FIG. 4a is a top view of a further embodiment of the healing abutment;

FIG. 4b is a longitudinal cross-sectional view of the healing abutmentshown in FIG. 4 a;

FIG. 5a is a top view of another embodiment of a healing abutment;

FIG. 5b is a longitudinal cross-sectional view of the healing abutmentshown in FIG. 5 a;

FIG. 6a is a top view of another embodiment of a healing abutment;

FIG. 6b is a longitudinal cross-sectional view of the healing abutmentshown in FIG. 6 a;

FIG. 7 is an exploded view of another embodiment of the presentapplication;

FIG. 8 is a side view of a method for stereophotographic imaging;

FIGS. 9a-9p are top views of a plurality of healing abutments having abinary-type system of information markers;

FIG. 9q is a top view of a healing abutment having a bar codeinformation marker;

FIG. 10 is a perspective view of a coordinate system of one embodimentof the present invention;

FIG. 11 is a perspective view of a stone model of an impression of amouth used with one embodiment of the present invention;

FIG. 12 is a perspective view of a 3-D CAD model of the stone model ofFIG. 11;

FIG. 13 is a perspective view of an altered 3-D CAD model of FIG. 12with the healing abutments removed from the CAD model;

FIG. 14 is a perspective view of an altered 3-D CAD model of FIG. 13with a custom abutment added in the CAD model;

FIG. 15 is a perspective view of a 3-D CAD model with an overmoldattached over the custom abutment and the adjoining teeth;

FIG. 16 is a perspective view of a rapid prototype of the overmold shownin the 3-D CAD model of FIG. 15 including an implant analog and anabutment;

FIG. 17 is a perspective view of an altered stone model of FIG. 11 withthe overmold of FIG. 16 attached;

FIG. 18 is a perspective view of the altered stone model of FIG. 17 withthe overmold removed and the implant analog placed in the stone modeland the patient-specific abutment connected to the implant analog;

FIG. 19a is a perspective view of an embodiment of an altered stonemodel of a mouth with abutments removed;

FIG. 19b is a perspective view of an alternative embodiment of analtered stone model of a mouth with abutments removed;

FIG. 20 is a perspective view of a 3-D CAD model of a custom abutmentand implant analog placed within a mouth;

FIG. 21 is a schematic representation of a robot manipulator systemadapted to place an implant analog into a stone model according toanother embodiment of the present invention;

FIG. 22 is a 3D computer model (a virtual model) of a portion of apatient's mouth;

FIG. 23 illustrates a robot that is used to modify the physical model ofthe patient's mouth;

FIG. 24 illustrates the robot of FIG. 23 as it modifies the healingabutment replica on the physical model to create an opening in thephysical model;

FIG. 25 illustrates the robot of FIG. 23 after it has created an openingin the physical model;

FIG. 26 illustrates the robot of FIG. 23 placing an implant analog inthe physical model;

FIG. 27 illustrates the details of the opening of the physical modelafter the robot of FIG. 23 has placed the implant analog therein;

FIG. 28 illustrates a flow diagram for use in creating a custom abutmentand modifying a physical model; and

FIG. 29 illustrates a flow diagram for use in creating a custom abutmentwith a CT scan.

While the invention is susceptible to various modifications andalternative forms, specific embodiments thereof have been shown by wayof example in the drawings and will herein be described in detail. Itshould be understood, however, that it is not intended to limit theinvention to the particular forms disclosed but, on the contrary, theintention is to cover all modifications, equivalents, and alternativesfalling within the spirit and scope of the invention as defined by theappended claims.

DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

As shown in FIGS. 1a and 1b , the healing abutment 10 of one embodimentof the present invention has a main body 15 with a generally circularcross-sectional shape, a first tapered section 17, a boundary 19, asecond tapered section 21, an end surface 23, a hex socket 25 anddimensions that are generally suitable for replicating the emergenceprofile of a natural tooth. The first tapered section 17 extendsdownwardly from the main body 15 of the abutment 10 having a diameter ata boundary 19 that is generally larger than the implant (not shown). Theboundary 19 separates the first tapered section 17 from the secondtapered section 21 that terminates in the end surface 23. The secondtapered section 21 is at an angle with the central axis of the implantthat is generally in the range from about 5 degrees to about 15 degrees,with 10 degrees being preferable. Alternatively, the second taperedsection 21 may be omitted such that the first tapered section 17 tapersdirectly to the diameter of the end surface 23 of the implant. In afurther embodiment, the first tapered section 17 may merge smoothly intothe second tapered section 21, without the distinct boundary 19separating the two tapered sections 17 and 21. The hexagonal orientationsocket or hex 25 is for mating with a hexagonal boss on the implant. Theend surface 23 has generally the same diameter as the seating surface ofthe implant.

FIG. 1b discloses the top view of the same healing abutment 10 shown inFIG. 1a . As shown in FIGS. 1a and 1b , the healing abutment 10 haspositive information markers 20 protruding from a top surface 29 of thehealing abutment 10. Each of the six positive information markers 20 isdisposed such that it aligns with the six corners of the underlying hex25. It is also contemplated in accordance with the present inventionthat the six information markers 20 may also correspond to the height ofthe healing abutment. For example, two information markers mightcorrespond to a 2 mm tall healing abutment and four information markersmight correspond to a healing abutment that is 4 mm tall. In theseembodiments, the two or four information markers would still be at thecorners of the underlying hex 25 so that the relative position of thehex is known.

A socket 30 on the exposed surface of a head portion 40 of an attachingbolt 50 is shaped to accept a wrench (not shown) for turning theattaching bolt 50 into the threaded bore of an implant 70, as shown inFIG. 1c . It is contemplated in accordance with the present inventionthat each of the healing abutments described herein and shown in thefigures can be secured to an implant by means of an attaching bolt, asis known in the art. An O-ring 60 carried on the head portion 40 of theattaching bolt 50 fills an annular gap left between the head and theentrance section near the outermost (widest) opening in the entrancesection.

A healing abutment 100 of FIG. 2a comprises many of the same features asthe healing abutment 10 shown in FIG. 1a . Dashed lines 125 in FIG. 2bcorrespond to the underlying hex 125 of the healing abutment 100 in FIG.2a . A top surface 129 includes negative information markers (recesses)120 that are displayed in FIG. 2a as dimples extending below the topsurface 129 of the healing abutment 100. The top surface 129 of thehealing abutment 100 also possesses six notches 130 that are machinedinto the corners. The top surface 129 is generally flat and merges intoa rounded shape at the periphery of the healing abutment 100.

The notches 130 are used, for example, to determine the identificationof the underlying implant hex position 125 or the height of the healingabutment or the diameter of the healing abutment. This embodiment is notlimited to comprising six notches in the top surface 129 of the healingabutment 100. It is also contemplated that one embodiment of the presentinvention may possess four notches or even two notches for indicativepurposes. Furthermore, it is contemplated that the information markerand notch approach could be combined or modified to provide informationregarding the underlying implant seating surface diameter and implanthex angulation.

In another embodiment of the present invention, a healing abutment 200shown in FIGS. 3a and 3b displays four positive information markers 220shown to, for example, indicate a 4 mm tall healing abutment 200. It iscontemplated that the number of information markers 220 could decreaseor increase depending on the height of the healing abutment 200 oranother variable that the information markers have been designated tocorrespond. The positive information markers 220 also define acorresponding one of the six flat surfaces of an underlying hex 225.Furthermore, dashed lines 225 in FIG. 3b correspond directly to theunderlying hex 225.

Two notches 230 have also been etched or machined onto a top surface 229of the healing abutment of FIG. 3b . These notches may indicate thediameter of the implant's seating surface. Lines 240 are scribed on thetop surface 229 of the healing abutment 200. The lines 240 are used toprovide positioning or other information to the dentist or laboratory.Here, the lines 240 indicate the diameter of the healing abutment (e.g.,4 mm). In summary, the number of the positive information markers 220indicates the height of the healing abutment 200. The position of thepositive information markers 220 indicates the orientation of the hex225 that is the orientation of the hexagonal boss on the implant. Thenotches 230 indicate the diameter of the seating surface of the implant.The lines 240 indicate the diameter of the healing abutment 200.generally

In yet another embodiment of the present invention, a top surface 329 ofthe healing abutment 300 of FIGS. 4a and 4b comprises an etched ormachined hex 335. Corners 322 of the etched hex 335 correspond directlyto the position of the corners of an underlying hex 325 shown in FIG. 4a. It is contemplated in accordance with one embodiment of the presentinvention that further information markers may be added to the healingabutment for the dentist or laboratory to ascertain different heights ordiameters.

A top surface 429 of a healing abutment 400 shown in FIGS. 5a and 5bcontains an etched or machined triangle 435. Dashed lines 425 in FIG. 5bindicate the location of an underlying hex 425. Corners 422 of theetched triangle 435 correspond to three of the six corners of theunderlying hex 425. Furthermore, two negative information markers 420are shown in FIG. 5b . As above, it is contemplated in accordance withthe present invention that fewer than six information markers may existto account for differing heights or diameters of the healing abutments.

Another embodiment of the present invention is shown in FIGS. 6a and 6b. The healing abutment 500 displayed in FIGS. 6a and 6b is a shorterversion of the healing abutment 10 shown in FIGS. 1a and 1b . Twopositive information markers 520 are shown in FIG. 6b to identify theheight of the healing abutment 500. Dashed lines 525 of the healingabutment 500 correspond with the location and orientation of theunderlying hex 525. Two notches 530 are also shown in a top surface 529of this embodiment of the present invention to show the orientation oftwo of the underlying flats of the underlying hex 525. A numeral “4” at537 is located on the top surface 529 of the healing abutment 500 toindicate, for example, the diameter of the healing abutment 500. Asshown, the numeral “4” at 537 corresponds to a healing abutment 500 witha diameter of 4 mm. It is contemplated in accordance with the presentinvention that other numerals could be placed on the top surface 529 ofthe healing abutment 500 to indicate other healing abutment diameters.Further, it is also contemplated that the numeral could represent theheight of the healing abutment or the diameter of the underlyingimplant.

During the second stage of the prosthetic implementation process andafter a healing abutment with the information markers has been placed,an impression of the mouth is made with only the healing abutments asdescribed herein and without the use of an impression coping. A model ofthe impression is poured with, for example, die stone. Since theinformation markers are disposed on the top and/or side of the healingabutment, the laboratory has all necessary information to define thegingival aperture, the implant size and the orientation of theunderlying hex. This enables the laboratory to quickly prepare thepermanent components. The system of the present invention also allowsthe maintenance of the soft-tissue surrounding the healing abutmentwhere in prior systems the soft tissue would close once the healingabutment was removed. The system spares the patient from the pain ofremoving the healing abutment.

To create a permanent prosthesis, the dental region is scanned, asdescribed above, from a stone model, from the impression material, ordirectly in the mouth using a laser scanning technique, a photographicscanning technique or a mechanical sensing technique. FIG. 8 showsstereophotographic imaging, one method used for scanning.Stereophotography with a camera 703 is performed directly on the mouthcavity 705 of the patient 707. A clinician can photograph implants andother components that have been placed into or adjacent the patient'sjawbone 709.

The scanned information is then transferred into a graphical imagingprogram for analysis. The graphical imaging software program, due to theinformation markers on the surface of the healing abutment, can performa wide variety of functions. The graphical imaging program can scan anopposing cast in order to develop an opposing occlusal scheme and relatethis information back to the primary model. This feature is extremelyimportant because many clinical patients have implants in both maxillaryand mandibular locations.

The graphical imaging software program is capable of generating athree-dimensional image of the emergence profile contours used on thehealing abutment. If the implant is not placed in the desired estheticlocation, the software program relocates the position of the restorationemergence through the soft tissue. The graphical imaging softwareprogram is also able to accurately relate the gingival margin for allmold, model, implant and abutment dimensions. The software creates atransparent tooth outline for superimposition within the edentuloussite. The occlusal outline of the “ghost” tooth should, if possible, beaccurate and based on the scanned opposing occlusal dimensions. It iscontemplated in accordance with the present invention that an occlusaloutline is created by scanning a wax-up in order to maintain a properplane of occlusion and healing abutment height.

The software program subtracts a given dimension from the mesial,distal, buccal, lingual, and occlusal areas of the superimposed toothdimension. This allows for an even reduction of the healing abutmentduring fabrication to allow for proper thickness of the overlyingmaterials (e.g., gold, porcelain, targis, etc.). The graphical imagingsoftware program also incorporates angulation measurements into thecustom abutment and subsequently calculates the dimensions of theprosthesis that are checked and modified, if necessary, by a laboratorytechnician. Each of the features is analyzed and determined from thedifferent information markers that exist on the healing abutments of thepresent invention.

The final dimensional information determined by the graphical imagingcomputer program is transferred from the computer to a milling machine(e.g., a 5-axis milling machine) to fabricate the custom abutment. It iscontemplated in accordance with the present invention that the customabutment can be fashioned from gold or titanium or other similar metalsor composites. A custom milled coping can then be fabricated. It iscontemplated in accordance with the present invention that the custommilled coping can be formed from titanium, plastic, gold, ceramic, orother similar metals and composites.

FIG. 7 shows the exploded view of another embodiment of the presentinvention. A cap 602 is placed on a healing abutment 600 and laterremoved during the process of taking the impression of the healingimplant and surrounding features of the patient's mouth. It iscontemplated in accordance with the present invention that the cap 602could be formed from plastic or metal or a composite material. As shownin FIG. 7, notches 604 are formed in the side(s) of the healing abutment600. These notches correspond to notches 606 that have been preformed inthe cap 602. When the cap 602 is placed onto the healing abutment 600,the cap only fits snugly and properly if the number of notches 606 inthe cap 602 corresponds exactly to the number of notches 604 in the sidewall(s) of the healing abutment. It is contemplated in accordance withthe present invention that there could be many less or more notches thanis depicted in FIG. 7. These notches correspond to informationparameters such as healing abutment height, healing abutment and/orimplant diameter and other parameters as listed above.

Specifically, after the healing abutment has been secured to theimplant, the cap 602 is securely placed over the top of the healingabutment 600. The impression material is then placed over the top of thecap 602. The impression is then either scanned in the patient's mouth orthe impression material (with the cap 602) is then scanned and theprocess continues as described above.

FIGS. 9a-9p depict yet another embodiment of the present invention.Specifically, FIGS. 9a-9p show the top view of a plurality of healingabutments, each of which has four marking locations on the top surfaceof the healing abutment. For each healing abutment, a marker is eitherpresent or absent in each of the four marking locations, and thepresence or absence can be interpreted either visually or by a scanningdevice. As explained below in detail, the markers in the markinglocations permit identification of healing abutment characteristics,such as dimensions of the healing abutment.

In FIGS. 9a-9p , the four rows correspond to four different healingabutment heights (e.g., 3 mm, 4 mm, 6 mm, and 8 mm). The four columns ofthe coding key correspond to four different diameters of the healingabutment seating surfaces (e.g., 3.4 mm, 4.1 mm, 5.0 mm, and 6.0 mm).Accordingly, sixteen unique healing abutments are present.

The top surface of each of the healing abutments has from zero to fourinformation markers located in the four marking locations. As shown inFIGS. 9a-9p , the marking locations extend radially from a centralregion of the healing abutment to the outer region of the top surface ofthe healing abutments (i.e., at locations of 12 o'clock, 3 o'clock, 6o'clock, and 9 o'clock).

As is well known, a binary-coded system exists as an array of digits,where the digits are either “1” or “0” that represent two states,respectively, ON and OFF. For each marking location, the presence of amarker (“ON”) is a 1 and the absence of a marker (“OFF”) is a 0. Bygrouping sets of 1's and 0's together, information about each healingabutment is known. In the illustrative embodiment, the determination ofthe sets of l's and 0's derived from the information markers (e.g., viavisual inspection, scanning in the mouth, scanning of the impression, orscanning of the model created by the impression) provide information onthe height of the healing abutment and the diameter of the seatingsurface of the attached implant.

The information markers shown in FIGS. 9a-9p are in the form of grooveshaving rounded cross-sections. The present invention, however, providesthat the cross-section of these grooves can be rectangular, triangular,or various other shapes. When an impression is created from the healingabutment, the grooved marking locations produce a protruding“mound”-like element in the impression. This impression is then scannedso that identifying features regarding the healing abutment can beobtained. Alternatively, a model of the patient's mouth is created fromthe impression such that the markings are again grooves in the modelthat substantially replicate the grooves in the healing abutments. Ofcourse, the markers could also be protrusions instead of grooves.Further, if the unique characteristics of the healing abutment are to beidentified through scanning in the mouth or simply visual scanning bythe clinician, then markers not producing features in impressionmaterial, such as etched or laser marking, may also be used.

Turning now to the specifics of each healing abutment, FIG. 9aillustrates a top view of a healing abutment 801 that includesorientation pick-ups 802. These orientation pick-ups 802 are alsopresent in each of the healing abutments shown in FIGS. 9b-9p . The mostcounterclockwise of the orientation pick-ups 802 (i.e., the horizontalpick-up at the lower region of FIGS. 9a-9p ) is always parallel to oneflat of the implant hex, as viewed from the top of the healing abutment.As shown, the orientation pick-ups 802 are a pair of bevels on the sidesof the healing abutments in FIGS. 9a-9p . Alternatively, the orientationpick-ups 802 can be grooves or protruding ridges, as well.

The orientation pick-ups 802 serve a second function in that theydictate which of the four marking locations is the first markinglocation. The other three marking locations are then read in clockwiseorder, proceeding from the most counterclockwise pick-up 802 to theother three marking locations on the top surface of the healingabutment. In other words, as illustrated in FIGS. 9a-9p , theinformation marker at 6 o'clock is the first digit in the binary code,the information marker at 9 o'clock is the second digit in the binarycode, the information marker at 12 o'clock is the third digit in thebinary code, and the information marker at 3 o'clock is the fourth digitin the binary code. In summary, the position of the orientation pick-ups802 allows for the determination of the position of one of the hex flatsof the healing abutment (and, likewise, one of the hex flats on theimplant), and also the starting point to check for the presence orabsence of information markers.

The results of a scan (computer or visual) of the four informationmarkers on the healing abutment 801 produce no information markers atthe four marking locations on the healing abutment 801 of FIG. 9a .Thus, the binary code for the healing abutment 801 is 0000, indicatingthat no grooved marker is present in any of the four predeterminedpositions. Since the coding key is preset (on a chart or in computersoftware), the binary code 0000 indicates that the healing abutment 801is a resident of first row and first column of the matrix depicted byFIG. 9, having a height of 3 mm and a seating surface diameter of 3.4mm. Thus, the three distinct pieces of information obtained from the topof the healing abutment allow the clinician or laboratory to know (i)the orientation of the hex of the implant, (ii) the height of thehealing abutment (i.e., the location of the implant's seating surfacebelow the healing abutment), and (iii) the seating surface diameter ofthe healing abutment (or the size of the implant's seating surface).

The healing abutment 806 in FIG. 9b possesses a binary code of 0100because only one information marker 807 is present in the second markinglocation. Thus, it is understood from the binary code that the healingabutment 806 is 3 mm in height and has a seating surface diameter of 4.1mm. The two healing abutments 811, 816 in FIGS. 9c, 9d have binary codesof 1000 and 1100, respectively. Healing abutment 811 has an informationmarker 812 in the first marking location, while healing abutment 816 hasinformation markers 817, 818 in the first two locations. Thus, theunique characteristics of these two healing abutments are known.

The healing abutments 821, 826, 831, 836 shown in FIGS. 9e-9h and havingheights of 4 mm, but with varying seating surface diameters, would beinterpreted as having binary codes 0010, 0110, 1010, and 1110,respectively. Healing abutment 821 has one information marker 822present in the third marking location, thus resulting in a binary codeof 0010, which is indicative of a healing abutment height of 4 mm and aseating surface diameter of 3.4 mm. Similar analyses on healing abutment826 with information markers 827, 828, healing abutment 831 withinformation markers 832, 833, and healing abutment 836 with informationmarkers 837, 838, 839 allow determinations of the unique characteristicsof these healing abutments.

The healing abutments 841, 846, 851, 856 shown in FIGS. 9i-9l and havingheights of 6 mm, but with varying seating surface diameters, would beinterpreted as having binary codes 0001, 0101, 1001, and 1101,respectively. Healing abutment 841 has one information marker 842present in the fourth marking location, thus resulting in a binary codeof 0001, which is indicative of a healing abutment height of 6 mm and aseating surface diameter of 3.4 mm. Similar analyses on healing abutment846 with information markers 847, 848, healing abutment 851 withinformation markers 852, 853, and healing abutment 856 with informationmarkers 857, 858, 859 allow determinations of the unique characteristicsof these healing abutments.

The healing abutments 861, 866, 871, 876 shown in FIGS. 9m-9p and havingheights of 8 mm, but with varying seating surface diameters, would beinterpreted as having binary codes 0011, 0111, 1011, and 1111,respectively. Healing abutment 861 has two information markers 862, 863,which is indicative of a healing abutment height of 8 mm and a seatingsurface diameter of 3.4 mm. Similar analyses on healing abutment 866with information markers 867, 868, 869, healing abutment 871 withinformation markers 872, 873, 874, and healing abutment 876 withinformation markers 877, 878, 879, 880 allow determinations of theunique characteristics of these healing abutments.

While the matrix of the sixteen healing abutments in FIGS. 9a-9p showfour implant seating surface diameters and four heights, the matrixcould include other physical characteristics of the healing abutment.For example, the maximum diameter of the healing abutment could beinformation obtainable through the binary-coded system. The type offitting on the healing abutment and, thus, the implant (i.e., internalhex or external hex) could be provided. Information unrelated to thehealing abutment, but related to only the implant, could be used. Forexample, the manufacturer of the implant could be noted. Or, informationregarding the type of screw that mates with the internally thread boreof the implant could be provided.

Further, while FIGS. 9a-9p demonstrate the ability of the four digit,binary-coded system to provide two physical characteristics of thehealing abutment, it could provide three or more physicalcharacteristics. For example, two seating surface sizes, four heights,and two maximum diameters would provide sixteen unique healingabutments. If more information were needed, a fifth marking locationcould be added to provide the opportunity for displaying thirty-twophysical characteristics of the healing abutments and/or implant. And,while one marking location has been shown with marker, it is possible tohave two or more markers in each marking location. For example, onecircumferential groove and one radial groove within one location couldrepresent two digits of a binary system. Alternatively, having twowidths possible for each groove could provide additional indiciarepresentative of certain information about the healing abutment.

While the invention has been described with round healing abutments,healing abutments anatomically shaped like teeth can take advantage ofthe information markers. Thus, the set of healing abutments couldinclude components shaped like the various teeth, and the informationmarkers could provide the information regarding which tooth shape ispresent on the healing abutment. For example, a set may include fourtypes of molar-shaped healing abutments, four types of bicuspid-shapedhealing abutments, four types of incisor-shaped healing abutments andfour types of round abutments. The four information marker locations oneach component in the set provide the information to determine which oneof the sixteen healing abutments is being used.

It is contemplated that the present invention also covers a set of eightunique healing abutments (as opposed to the sixteen shown) requiringonly three marking locations. The computer software and/or the visualchart in this situation would identify these eight unique healingabutments through binary codes possessing three digits. The potentialbinary codes corresponding to an ON or OFF determination at the threemarking locations are 000, 100, 010, 001, 110, 101, 011, and 111.Similarly, if the set has only four unique healing abutments, only twomarking locations would be required on the healing abutments todetermine features regarding the healing abutment and the attacheddental implant. The potential binary codes in a four healing abutmentmatrix are 00, 10, 01, and 11.

After the top surface of a healing abutment (or the impression of thetop surface, or the model of the impression of the top surface) isanalyzed, the orientation of the hex is known from the location of theorientation pick-ups 802 and, via the binary code, the abutment heightand the seating surface of the healing abutment is known. Otherinformation regarding the healing abutment and the attached implant canalso be determined by adding other markers of the type previously shown.

In addition to the markers described, it is further possible to providea bar-coded system for providing information about the particularcomponent, as shown in FIG. 9q . The bar code 894 can be located on thetop surface on the healing abutment 892 such that it can be scanned orread easily. Thus, the bar code 894 would provide the same type ofinformation described above with respect to the information markers.

Referring to FIG. 10, when scanning techniques are used to learn of theinformation on the top of the healing abutment, the computer software isable to determine the position and orientation of the implant 900relative to the adjacent teeth. The position of the implant 900 isdefined in a Cartesian coordinate system having “X,” “Y,” and “Z” axes.The common point is at the intersection of the centerline of the implantand a plane 920 representing the seating surface 925 of the implant 900.

As noted above, the information markers assist in determining the heightof the healing abutment above the implant. This height can be used toidentify the zero point on the “Z” axis, which is in the plane 920containing the seating surface 925 of the implant 900. The “Y” axis 910is within the plane 920 representing the seating surface 925 with thepositive-“Y” direction as close to the direction of facial to buccal aspossible. The “X” axis 915 is in the plane 920 and is perpendicular toan implant hex face. Thus, the width of the seating surface 925 in theplane 920 is known, as is the width of the healing abutment emergingthrough the gingiva. Thus, the emergence profile of the artificial toothis known, as well.

Turning now to FIG. 11, a perspective view of a stone cast 1000 of amouth of a patient is shown with a stone-cast model of a healingabutments 1002 which has configurations on its upper surface thatcorresponds to the healing abutments previously described. The stonecast 1000 is made from an impression of the mouth as previouslydescribed.

Once the stone cast 1000 is prepared, it is scanned using a scanningtechnique previously described, the scanned data is transferred into agraphical imaging program, such as a Computer Aided Design (“CAD”)program so that a three-dimensional (“3-D”) CAD model 1100 of the stonecast 1000 (FIG. 11) is created, as shown in FIG. 12.

As shown in FIG. 13, the CAD model 1100 (FIG. 12) of the stone cast 1000(FIG. 11) is modified to create a first modified CAD model 1200 thatremoves the healing abutment 1002 (FIG. 11) so that the position of animplant 1202, or the top surface of an implant, underlying the healingabutment 1002 (FIG. 11) is displayed.

The CAD program is additionally used to design a custom, patientspecific, abutment adapted to attach to the implant 1202. The customabutment supports a final prosthesis, often referred to as a crown. Amodified version of the stone model 1000 is used to design the crown tofit between the adjacent teeth based on the specific dimensions andconditions of a patient's mouth. Thus, obtaining an accurate position ofthe dental implant is critical to designing an accurate crown. Once theCAD program has been used to design a custom abutment, the design of thecustom abutment is input into a precision manufacturing device, such asa CNC milling machine, to create the custom abutment from a blank ofmetal, usually titanium, or a titanium alloy, or from a ceramicmaterial.

As shown in FIG. 14, a CAD model of a custom abutment 1402 is shownlocated between a CAD model of the adjacent teeth 1404 that has beencreated by scanning the stone model 1000. Using the CAD program, anovermold 1502 is created, as shown in FIG. 15. The overmold 1502 fitsover the custom abutment 1402 and the adjacent teeth 1404 in the 3-D CADmodel 1400. The overmold 1502 is adapted to fit over a stone model ofthe patient's teeth to allow an actual custom abutment 1604 (FIG. 18) tobe positioned in substantially the identical location and orientation asthe custom abutment 1402 in the 3-D CAD model 1400.

Once the overmold 1502 has been designed in the 3-D CAD model 1400, theCAD program allows a rapid prototype overmold 1602 (FIG. 16)corresponding to the 3-D CAD model of the overmold 1502 to be createdusing rapid prototype equipment. It is contemplated that many rapidprototyping techniques may be utilized with the present invention suchas: stereolithography, laminated-object manufacturing, selective lasersintering, solid ground curing, or other known rapid prototypingprocesses. The 3-D CAD model of the overmold 1502 is used by theequipment controlling the rapid prototype equipment to create the rapidprototype overmold 1602.

Turning now to FIG. 16, a rapid prototype assembly 1600 is shown havingthe rapid prototype overmold 1602, a custom abutment 1604, and animplant analog 1606. The rapid prototype overmold 1602 is adapted toreceive the custom abutment 1604 via a snap-fit connection created bysnapping the overmold 1602 over an edge of the custom abutment 1604. Itis additionally contemplated that a press fit may be used to secure acustom abutment to a rapid prototype overmold by using an interferencefit. The custom abutment 1604 is secured to the implant analog 1606using a screw.

The custom abutment 1604 (FIG. 18) produced on the precisionmanufacturing device must then be placed within an altered stone model1700 as shown in FIG. 17, so that the crown may be created. The alteredstone model 1700 has had the healing abutment 1002 from the stone cast1000 (FIG. 11) removed, so that an opening 1702 is present where thehealing abutment 1002 from the stone cast 1000 (FIG. 11) had beenlocated. The opening 1702 is of a sufficient size so as to receive theimplant analog 1606. A gap 1706, or a hole large enough to receive animplant analog, exists in the stone model 1700 between the implantanalog 1606 and the walls defining the opening 1702. The rapid prototypeassembly 1600 is placed over the stone model 1700, positioning thecustom abutment 1604 and the implant analog 1606 as in the 3-D CADmodel. The gap 1706 is then filled with a securing material, such asepoxy, to secure the implant analog 1606 to the stone model 1700. Oncethe securing material sets, the implant analog 1606 is properlypositioned within the stone model 1700, at substantially the samelocation as the implant in the patient's mouth relative to the teethadjacent to the implantation site. The implant analog 1606 and thecustom abutment 1604 may be removed from the rapid prototype overmold1602, as shown in FIG. 18. The final prosthesis may then be createdusing the stone model 1700 having the properly positioned implant analog1606 and custom abutment 1604.

Thus according to the present invention, the same stone model may beused for a scanning process to make the patient specific custom abutment1604 and for receiving an implant analog 1606 for mating with the customabutment 1604 to develop a final prosthesis.

While the preceding embodiment has been described for creating a finalprosthesis, it is contemplated that the process may be used to create atemporary prosthesis as well.

According to anther embodiment of the present invention, an implantanalog is placed within a stone model using a robot manipulator. Aspreviously described herein, a stone cast 1000 of a mouth of a patientis produced from taking an impression of the patient's mouth. The stonecast is scanned to generate a 3-D CAD model 1100 of the stone cast 1000.The CAD program is used to design a custom abutment 1604. The customabutment 1604 is produced on a precision manufacturing device usinginformation from the CAD program.

As shown in FIG. 19a , a modified stone cast 1900 is created by removinga section of the stone cast 1000 that contains the healing abutment 1002(FIG. 11). The CAD program used to generate the custom abutment 1604 isused to generate a 3-D CAD model containing a custom abutment having animplant analog attached. Thus, a 3-D CAD model 2000 exists where theproper position of the implant analog 2002 relative to adjacent teeth2004 is created as shown in FIG. 20. Using a coordinate system withinthe 3-D CAD model 2000, the relative position of the implant analogs2002 and the adjacent teeth 2004 may be generated. A common base plate2106 (FIG. 21) may be used in scanning the stone cast 1000 and inplacing an implant analog 2102 (FIG. 21) using a robot manipulator 2100(FIG. 21). The robot manipulator 2100 (FIG. 21) is located at a knownposition relative to the base plate 2106 (FIG. 21). A scanner measuresan X, Y, and Z position of the healing abutment 1002 in the stone cast1000 relative to axes on the base plate 2106, also referred to as thebase plate 2106 origin. Thus, when the base plate 2106 is in a knownposition with respect to the robot manipulator 2100, an exact locationof an implant analog 2102 (FIG. 21) may be determined.

Once the relative position of the implant analog 2002 and the adjacentteeth 2004 has been generated, this position information is input to arobot manipulator. The robot manipulator 2100 uses the relative positioninformation to place an implant analog 2102 into a securing material2104, such as epoxy, located on the modified stone cast 1900 where thehealing abutments had been located, as shown schematically in FIG. 21.The robot manipulator 2100 is able to accurately place the implantanalog 2102 in the securing material 2104, such that the position of theimplant analog 2102 within the modified stone cast 1900 is substantiallyidentical to the position of the implant analog 2002 within the 3-D CADmodel 2000.

According to a further alternative embodiment of the present invention,instead of using a robot manipulator to place an implant analog into asecuring material of a modified stone cast, the robot manipulator mayinstead be a multiple handed robot manipulator adapted to drill a hole1902 in a stone cast 1901 (as shown in FIG. 19b ) with a first hand, andplace an implant analog in the hole with a second hand. One example of arobot that performs multiple drilling functions and accurately placesthe implant analog into the drilled hole in the stone cast 1901 isdescribed with reference to FIGS. 22-28.

FIG. 22 is similar to FIG. 20 in that it illustrates a 3-D CAD model2200 (on a computer display) of a virtual custom abutment 1604 and avirtual implant analog 2202 that are adjacent to teeth 2204 after astone cast of the patient's mouth has been scanned. An opening 2206 inthe CAD model 2200 is tapered as it leads towards the virtual implantanalog 2202. This tapering is chosen by the operator of the CAD model2200 after consideration of the location of the underlying dentalimplant that has been dictated by the stone cast model having thehealing abutment (e.g., replica of the healing abutment 1002 in stonecast model 1000 in FIG. 11) and the location of the adjacent teeth 2204.Further, the tapering is also dictated by the size and shape of thevirtual custom abutment 1604 that has been designed by the operator.Although the opening 2206 has been illustrated having a straight-walltaper, the opening 2206 may have a curved-wall taper. Further, theopening 2206 at its terminal and may be circular, elliptical, or othernon-circular shapes as dictated by the virtual custom abutment 1604 andthe three-dimensional “saddle” shape of the gingival tissue between theleft and right adjacent teeth 2204. This opening 2206 may be created bythe robot manipulator 2100 of FIG. 21, or the alternative robot 2300discussed with reference to FIGS. 23-27.

FIG. 23 illustrates a simple schematic construction for a robot 2300.The skilled artisan would appreciate that numerous types of robots areavailable having various control features, motors, and manipulating armsand tools. For example, the robot 2300 could be an Epson PS5 six-axisrobot with an Epson RC520 controller. The robot 2300 in FIGS. 23-27performs various functions related to modifying the stone cast 1000 andplacing the actual implant analog. In particular, as will be describedin more detail below, the robot 2300 modifies the stone cast 1000 tocreate an actual opening that is substantially similar to the virtualopening 2206 in FIG. 22. Further, the robot 2300 places an implantanalog in substantially the same position and with substantially thesame orientation as the virtual implant analog 2202 in FIG. 22.

The robot 2300 includes a base structure 2302 that is supported on atable or other work bench. The base structure 2302 typically has one ormore moving arms 2304 having a terminal structure 2310 for supportingone or more tool holders 2312, 2314 that grip and/or manipulate tools orother components. As shown, the base structure 2302 includes an arm 2304having multiple pivotable sections 2304 a and 2304 b, and the toolholder 2312 includes a drill bit 2320. The terminal structure 2310, thearm 2304, the base structure 2302, and/or the tool holders 2312, 2314include gears and other common components for transmitting rotationalenergy to a tool (e.g., the drill bit 2320) being held by one of thetool holders 2312, 2314.

The arm 2304 (and thus the terminal structure 2310) can be moved in alldirections relative to the stone cast 1000 and a pallet 2340. The pallet2340 includes a specific sequence of tools or other components that areplaced within the pallet 2340 prior to the operation of the robot 2300.As shown, the pallet 2304 includes an additional drill bit 2342 at onelocation and an implant analog holder 2344 at a second location.Typically, after the data from the 3-D CAD model 2200 of FIG. 22 istransferred to the control system for the robot 2300, the operator ofthe robot 2300 will be instructed to provide a certain sequence of toolsor other components in the pallet 2340 to accommodate the development ofthe particular opening and the placement of the particular implantanalog for the case.

In FIG. 23, the stone cast 1000 is directly coupled to a base structure2350 that is the same base structure that was used for scanning thestone model 1000 prior to development of the virtual custom abutment1604. As such, the base structure 2350 is used in both the scanning ofthe stone cast 1000 and in the later modification of the stone cast 1000by the robot 2300. The base structure 2350 includes alignment featuresand magnetic features for precision mating with corresponding structureson a work structure 2352 associated with the robot 2300. The workstructure 2352 is at a known location relative to the base structure2302 such that any tool or other component within the tool holders 2312,2314 can be accurately positioned relative to be work structure 2352.

To help arrange for the precision location of the tool 2320 relative tothe stone cast 1000, the stone model 1000 (and its base structure 2350)has an abutment coordinate system, which is labeled as X_(A), Y_(A),Z_(A), for locating the custom abutment, which will ultimately fit onthe implant analog to be located within the opening in the stone cast1000. Further, the robot 2300 (and the scanning system previously used)has its own base coordinate system, which is labeled as X_(B), Y_(B),Z_(B).

When the data from the 3-D CAD model 2200 is transferred to the controlsystem for the robot 2300, the data includes at least three types ofdata sets. A first data set will indicate the type of implant analogthat will be used in the stone cast 1000. A second data set willindicate the relative location of the abutment coordinate system to thebase coordinate system so that the creation of the hole in the stonecast 1000 and the placement of the implant analog is substantiallyidentical to that which has been virtually modeled. A third data setwill define the gingival margin of the custom abutment 1604 (e.g.,having a saddle shape) so that a properly sized opening can be createdabove the implant analog, allowing the custom abutment to fit properlywithin the stone cast. This third data set is helpful because the actualcustom abutment is larger in diameter than the implant analog such thatthe opening must be contoured in a tapered fashion (e.g., straight-walltaper, curved wall taper, etc) to accommodate the actual customabutment.

The robot 2300 of FIG. 23 may also include a calibration mechanism 2360such that the tool (e.g., the tip end of drill bit 2320) is placed at aknown location and “zeroed” before developing the opening and/orplacement of the implant analog. As shown, the calibration system 2360includes two intersecting lasers (e.g., HeNe lasers) 2362, 2364. Priorto any work on the stone cast 1000, the tool is placed at theintersection of the two lasers 2362, 2364 to insure accuracy of the toolwithin the base coordinate system (X_(B), Y_(B), Z_(B)). The operatorcan slightly adjust the tool to place it at the intersection of the twolasers 2362, 2364, assuming the calibration system 2360 indicates thatan adjustment is needed or if the operator can visualize that anadjustment is needed. Once calibration is complete, the robot 2300 movesthe tool 2320 directly over the stone replica of the healing abutment1002, as shown in FIG. 23, as part of a visual verification step. Whenthis occurs, the operator knows that the data entered into the robot2300 is correct as the robot 2300 is now ready to begin modification ofthe stone model 1000. Had the drill bit 2320 been placed over theadjacent teeth, and not the stone replica of the healing abutment 1002,then the operator would know that incorrect data has been loaded.

In FIG. 24, the drill bit 2320 has been moved by the robot 2300 on tothe stone replica of the healing abutment 1002 to begin the developmentof the opening in the stone model 1000. Particles 1002 a of the healingabutment 1002 are disbursed from the stone model 1000 as the drill bit2320 works on the stone replica of the healing abutment 1002. Initially,the drill bit 2320 removes the most, if not all, of the protrudingstructure of the stone replica of the healing abutment 1002. In someinstances, corners sections of the protruding structure may remain. Thedrill bit 2320 then creates the contoured pocket of the opening (asdictated by the tapered opening 2206 in FIG. 22). The drill bit 2320 hasa smaller diameter than any portion of the opening such that it is usedas a milling tool to create the contoured pocket. The drill bit 2320then creates the lower portion of the opening that will receive theimplant analog. In doing so, the drill bit 2320 of the robot 2300creates a bottom wall to the opening that is located at a positionwithin the stone cast 1000 that will cause the particular implant analogfor that case to have its upper mating surface (see FIG. 27) at alocation that is substantially identical to the location of the implantin the patient's mouth, as indicated by the healing abutment that wasplaced within the patient's mouth and subsequently scanned to developthe 3-D CAD model 2200 of FIG. 22. In doing so, the system takes intoaccount the fact that the implant analog will be held in position in theopening by an adhesive (discussed below), such that it may be suspendedin the opening and not in contact with the walls of the opening.

FIG. 25 illustrates the end result of the opening 2380 that was createdin the stone cast 1000 by the robot 2300. While the development of theopening 2380 has been described by the use of a single drill bit 2320,it should be understood that the robot 2300 can utilize multiple tools(e.g., a second drill bit 2342 in the pallet 2340, or a more traditionalmilling tool) to create the opening 2380. Further, because the stonecast may contain multiple replicas of healing abutments 1002, the robot2300 may be required to create multiple openings 2380, each of whichuses multiple tools from the pallet 2340. The use of multiple tools mayrequire a calibration by the calibration system 2360 (FIG. 23) prior tothe use of each tool.

FIG. 26 illustrates the movement of the robot 2300 to grip an implantanalog holder 2344 from the pallet 2340 by use of the tool holder 2314for placement of the implant analog 2386. Once the opening 2380 has beencompleted, the operator will remove all remaining particles and debrisfrom the drilling process from the stone cast 1000. An adhesive isplaced within the opening 2380 and, optionally, also placed (e.g.,manually brushed) on the terminal end of the implant analog 2386.Alternatively, an adhesive activator agent is placed on the implantanalog 2386 to accelerate the curing process. It should be understood,however, that the work station for the robot 2300 can have bins ofadhesive (and activator agents) such that the robot 2300 “dips” the endof the implant analog 2386 into one or more of these bins without manualoperator intervention. Further, the robot 2300 may have an adhesiveapplicator tool in the pallet 2340 that is used to automatically placethe adhesive (and possibly the ideal amount of the adhesive) in theopening 2380.

After calibrating the location of the implant analog 2386 with thecalibration system 2360 (FIG. 23), the robot 2300 then moves the implantanalog holder 2344 in such a manner so as to place the implant analog2386 at the bottom of the opening 2380. In doing so, the orientation ofthe anti-rotational feature of the implant analog 2386 is critical suchthat it matches the orientation of the anti-rotational feature of theimplant in the patient's mouth (i.e., all six degrees of freedom areconstrained in the same manner as the implant that is located in thepatient's mouth). When the robot 2300 has finished placement of theimplant analog 2386 within the opening 2380, an energy source (e.g., UVlight source) is used to quickly cure the adhesive such that the implantanalog 2386 is physically constrained and attached to the stone model1000 within the opening 2380. Preferably, the adhesive is a UV-curableadhesive.

Once the adhesive has cured, the robot 2300 commands the grippingmechanism of the tool holder 2314 to release the implant analog holder2384. The implant analog holder 2344 is held to the implant analog 2386through a long screw. Thus, the operator removes the long screw suchthat the implant analog 2386 remains by itself within the opening 2380(attached via the adhesive), as is shown in FIG. 27. In particular, theimplant analog 2386 and its threaded bore 2390 and anti-rotationalfeature 2392, are located at a specific position and orientation withinthe opening 2380. It should be understood that the robot 2300 could alsoinclude the necessary tools (e.g. screwdriver tip) in the pallet 2350 torelease the implant analog holder 2344 from the implant analog 2386 sothat no operator intervention is required.

FIG. 28 illustrates a flowchart of the entire process that is used tocreate a custom abutment and the final restorative components that fitupon the custom abutment. At step 2502, a patient is fitted with adental implant and an associated healing abutment, like those shown inFIGS. 1-7 and 9. At step 2504, an impression of the patient's mouth istaken with the healing abutment(s) installed on the implant. At step2506, a stone cast (e.g., the stone cast 1000) of the patient's mouth isdeveloped from the impression of the patient's mouth. The stone castwould include a stone replica of the healing abutment(s) which providesinformation regarding the underlying dental implant as well as thegingival opening created by the healing abutment(s). The development ofthe stone cast may also include the development of a stone cast of theopposing (upper or lower) teeth, which are then placed in an articulatordevice, as is commonly known, to locate the stone cast relative to theopposing upper or lower set of dentition.

At step 2508, the stone cast is scanned so as to produce a virtual modelof the stone cast. This scanning step may also include the scanning ofthe cast of the opposing upper or lower dentition to constrain theheight of the eventual custom abutment that is designed andmanufactured. The opposing cast scan is articulated relative to theinitial cast scan. The articulation can be achieved through variousmethods. For example, the articulation axis from the articulator used toarticulate the physical casts can be stored in the computer (withrespect to a common calibration standard used with the scanner andarticulator) such that the opposing cast can be articulated correctly.Another example is the use of the “virtual articulation” software moduleavailable in the 3Shape Dental Designer software (3Shape A/S,Copenhagen, Denmark). This allows a set of casts to be articulated inthe computer by taking an additional scan in which the casts arepositioned in the articulated condition. The software uses ashape-matching algorithm to articulate the opposing cast scan relativeto the initial cast scan by referencing geometry from all three scans.

At step 2510, the scanned data of the stone cast is interpreted.Further, using the marker system associated with the set of healingabutments, a virtual healing abutment that matches the scanned data ofthe stone replica of the healing abutments is aligned with the scanneddata such that the exact location, size, and orientation of the entirehealing abutment (and, thus, the underlying dental implant) is known.For example, the operator may have a library of possible healingabutments and the one that matches the size and markers at the top ofthe scanned healing abutment is selected to be aligned on the scannedhealing abutment. Once the location and orientation of the underlyingdental implant is known, the operator preferably manipulates the modelto produce a 3-D CAD model of only the specific area containing thestone replica of the healing abutment(s), as is shown in FIG. 20 or 22,to decrease the amount of data required for the process.

Information resulting from step 2510 is then used for two purposes.First, it is used within step 2512 to design a virtual custom abutment(e.g., custom abutment 1604) with the use of the 3-D CAD model. The datais ultimately transferred to a milling machine to manufacture the actualcustom abutment. And second, the information from step 2510 can also besent to a robot (such as the robot 2100 in FIG. 21 or the robot 2300 inFIG. 23) at step 2514 to modify the stone cast that was developed instep 2506. As described above, this modification of the stone cast mayinclude the development of a contoured opening in the stone cast in thearea that was previously occupied by a stone replica of the healingabutment. Further, the modification may also include the placement ofthe implant analog, which as described above, can be accomplished by useof the same robot. In summary, step 2514 entails the methodology andprocesses that are generally discussed with reference to FIGS. 19-27.

At step 2516, the custom abutment that was manufactured in step 2512 canbe placed on the modified stone cast created in step 2514. In doing so,the final restorative component(s) (e.g., porcelain tooth-shapedmaterial to be cemented to the custom abutment) can be created on thecustom abutment, often by a dental laboratory. The development of thefinal restorative component(s) take into account the adjacent teeth inthe modified stone cast as well as the contour of the opening in thestone cast that leads to the implant analog. At step 2518, the customabutment and the final restorative component(s) are then sent to theclinician who installs the custom abutment and mating restorativecomponent(s) onto the dental implant.

As an alternate methodology to that which is shown in FIG. 28, at step2502, an impression can be taken of the patient's mouth prior toinstallation of the dental implants and the associated healing abutments(e.g., the very first visit to the clinician at which the dental implantinstallation is recommended to the patient). The stone cast from thatimpression is then scanned for later usage. After a subsequent visit inwhich the dental implant is installed along with the associated healingabutment, a scan of the patient's mouth with the associated healingabutment is created. That scanned data of the patient's mouth is thenmerged, via a shape-matching algorithm (e.g., a scanner and associatedsoftware from 3Shape A/S of Copenhagen, Denmark), with the initial scanof the stone cast. The result is that there is electronic data that isanalogous to the result of scanning the stone cast in step 2508 of FIG.28. In this alternative embodiment, step 2510 to 2518 would continue asdiscussed above with the primary difference being that the stone castmodified by the robot 2300 would lack the stone replica of the healingabutment that was described above with respect to FIGS. 23-26 since thestone replica was taken prior to installation of the healing abutment.

As a further option to the alternative procedure in the precedingparagraph, instead of a scan of the patient's mouth with the healingabutment in place, an abutment-level impression (as in step 2504) can betaken after the healing abutment and implant are installed and theimpression (or resultant stone cast) could be scanned by a lab. Thisscanned data could again be merged with the data set from the initialstone cast. In either of these two options, the primary advantage isthat overall process can be expedited. This is due to the fact that theentity that modifies the stone model already has the stone model in handand can begin altering the stone model with the robot once it receivesthe electronic transfer of the scan data from the (i) scan of thepatient's mouth with the healing abutment (as described in the precedingparagraph), or (ii) the scan of the impression of the patient's mouthwith the healing abutment (as described in this paragraph).

In a further alternative to either of the previous paragraphs, insteadof receiving a stone cast of the patient's mouth prior to installationof the dental implant and healing abutment, the entity involved with themodification of the stone model receives a CT scan of the patient'smouth. In doing so, the CT scan allows that entity to build a physicalstone model of the patient's mouth through a rapid prototypingtechnique. In other words, in this further alternative, there is no needto make a stone model or transfer a stone model created by an impressionof the patient's mouth. The CT scan and the subsequent transfer of thatscanned data allows for the creation of a model of the patient's mouththrough a rapid prototyping technique.

In yet another alternative, after the patient has been fitted with theimplant and the associated healing abutment, the patient receives a CTscan. That scanned data is then transferred to the entity involved withthe modification is stone model. That entity then uses the data from theCT scan to create a rapid prototyping, which will ultimately serve asthe stone model 1000 described above. Further, that same CT scan datacan be used to design manufacture the custom abutment. In other words,in such a methodology using a CT scan of the patient's mouth thatincludes the healing abutment, once a rapid prototype is built from thatscanned data, the methodology continues from step 2510 in FIG. 28.

In a further alternative, no healing abutments with informationalmarkers are necessary, as will be described with reference to FIG. 29.At step 2602, the CT scan of the patient's mouth is taken prior toinstallation of the implants (or any surgery). At step 2604, the CT scandata is then used to develop a surgical plan for the installation of thedental implants in the patient's mouth, which includes virtual implants“virtually” installed at certain locations of the patient's mouth. Fromthe surgical plan, at step 2606, a surgical guide is developed that fitsprecisely over the patient's gingival tissue and/or dentition. Thesurgical guide includes holes through which tissue punches and drillbits can be inserted to create an osteotomy. Further, the dentalimplants can be installed at a precise location and orientation byinsertion through the holes of the surgical guide that is precisely fitwithin the patient's mouth. As such, the CT scan allows for the virtualinstallation of the dental implant pursuant to the surgical plan, andthe building of a surgical guide that will allow the clinician toactually install the properly sized dental implant at the location andorientation dictated by the surgical plan. One example of the use of aCT-scan to develop a surgical plan involving a surgical guide isdisclosed in U.S. Patent Application Ser. No. 61/003,407, filed Nov. 16,2007, and described in Biomet 3i's Navigator™ system product literature,“Navigator™ System For CT Guided Surgery Manual” that is publiclyavailable, both of which are commonly owned and herein incorporated byreference in their entireties. Another example of the use of a CT-scanto develop a surgical plan is disclosed in U.S. Patent Publication No.2006/0093988, which is herein incorporated by reference in its entirety.

Once the CT scan is created and the surgical plan with the associatedvirtual implants is known, at step 2608, the CT scan data and virtualimplant data can be used to develop a cast, such as a rapid prototypemodel, that will ultimately replicate the conditions in the patient'smouth after the surgical plan is effectuated. As such, the CT scan dataand the surgical plan data can be used to develop a rapid prototypemodel of the patient's mouth. Further, this data can also be used toinstall implant analogs at locations within that rapid prototype modelthat correspond to locations of the virtual implants dictated by thesurgical plan. For example, the robot 2300 can be used to installimplant analogs in the rapid prototype model as described above withreference to FIGS. 23-27. Or, the rapid prototype manufacturing methodcan directly incorporate an implant analog structure without the use ofthe robot 2300, as described in some of the previous embodiments lackinga robot. Hence, the model of the patient's mouth with the implantanalogs can be developed before the patient has undergone any surgerywhatsoever (i.e., without the use of the previously disclosed healingabutments having the information markers). At step 2610, the model orcast is then used to develop a custom abutment (or a bar for attachmentto multiple implants and for receiving a denture) and the associatedrestorative components.

Once the surgical guide from step 2606 is completed, it can betransferred to the clinician for use in the patient at step 2612. Thus,the patient receives dental implants installed in accordance with thedental plan (i.e., the proper size implants, their orientation, andtheir location are finalized in the patient in accordance to virtualimplants of the surgical plan). Further, the custom abutment andrestorative components (e.g., porcelain tooth-shaped material,associated screw, etc) are transferred to the clinician and can beinstalled on the dental implants at step 2614. Consequently, under themethodology of FIG. 29, it is possible for custom abutment andrestorative components to be installed in the patient on the same daythat he or she receives the dental implants installed via the surgicalguide.

While the preceding embodiments have been described for creating a finalprosthesis, it is contemplated that the process may be used to create atemporary prosthesis as well.

While the preceding embodiments have been described by scanning a castof a patient's mouth, it is also contemplated that an intra-oral scan, aCT scan, or other known type of medical scan, may be taken to generatedata used for a 3-D CAD model.

While the preceding embodiments have been described using a healingabutment containing a variety of markings, it is further contemplatedthat a scanning abutment may be placed into a stone model before a scanis performed. According to such an embodiment, a first stone model of apatient's mouth would be made, and a portion of the first stone modelcorresponding to a healing abutment would be removed and replaced with ascanning abutment containing a variety of markings as previouslydescribed. A scan would then be performed of the first stone modelcontaining the scanning abutment, and a 3-D CAD model of the patient'smouth would be created. The 3-D CAD model would then be used aspreviously described.

While particular embodiments and applications of the present inventionhave been illustrated and described, it is to be understood that theinvention is not limited to the precise construction and compositionsdisclosed herein and that various modifications, changes, and variationsmay be apparent from the foregoing descriptions without departing fromthe spirit and scope of the invention as defined in the appended claims.

What is claimed is:
 1. A method of positioning an implant analog in aphysical model of a patient's mouth for use in creating a customabutment, the method comprising: scanning the physical model to developscan data of the physical model; transferring the scan data to a CADprogram; creating a three-dimensional model of at least a portion of thephysical model on the CAD program using the scan data; determining, inthe three-dimensional model, the location of the implant analog to beplaced in the physical model; developing implant-analog positionalinformation based on the location of the implant analog in thethree-dimensional model; developing an emergence profile contourinformation to provide for a contour of an opening to be made in thephysical model leading to the implant analog; transferring to a robot(i) the implant-analog positional information and (ii) the emergenceprofile contour information; by using at least one tool associated withthe robot, modifying the physical model by, creating the opening, theopening having an emergence profile corresponding to theemergence-profile contour information; and by using the robot, fixingthe implant analog within the opening of the physical model inaccordance to the implant˜analog positional information.
 2. The methodof claim 1, wherein the scanning is one of a laser scanning technique,mechanical scanning technique, photographic scanning technique,CT-scanning, and stereophotographic imaging technique.
 3. The method ofclaim 1, further including using the three-dimensional model to developabutment dimensional information related to a custom abutment to beplaced on the implant analog, and manufacturing the custom abutment fromthe abutment dimensional information.
 4. The method of claim 3, furtherincluding developing a patient-specific prosthesis that includes thecustom abutment, the patient-specific prosthesis being developed on themodified physical model.
 5. The method of claim 1, wherein the fixingincludes applying an adhesive between the implant analog and thephysical model.
 6. The method of claim 5, wherein the adhesive is aUV-curable adhesive and the fixing includes exposing the UV-curableadhesive to UV energy.
 7. The method of claim 1, further includescalibrating the location of the at least one tool prior to modifying thephysical model.
 8. The method of claim 7, wherein the calibratingincludes using a laser to calibrate the tool relative to a coordinatesystem associated with the robot.
 9. The method of claim 1, wherein thefixing the implant analog within the opening includes (i) grasping animplant-analog holder with the robot and (ii) once the implant analog isfixed within the opening, releasing the implant-analog holder from therobot.
 10. The method of claim 9, further including unscrewing a screwthat attaches the implant analog to the implant-analog holder after anadhesive has been applied between the physical model and the implantanalog.
 11. The method of claim 10, further including calibrating thelocation of the implant-analog holder with a calibration system prior tofixing the implant analog within the opening.
 12. The method of claim11, further includes calibrating the location of the at least one toolprior to modifying the physical model.
 13. The method of claim 1,wherein the physical model includes healing abutment informationalmarkers, and the determining the location of the implant analog to beplaced in the physical model includes gathering information from thehealing abutment informational markers.
 14. The method of claim 13,wherein the gathered information from the healing abutment informationalmarkers includes information related to the size of an implant in thepatient's mouth and the height of a healing abutment in the patient'smouth.
 15. A method of affixing an implant analog in a physical model ofa patient's mouth for use in creating a custom abutment, the methodcomprising: determining, in a three-dimensional virtual model of thepatient's mouth, the location of the implant analog to be placed in thephysical model; developing implant-analog positional information basedon the location of the implant analog in the three-dimensional virtualmodel; developing an emergence profile contour information to providefor a contour of an opening to be made in the physical model leading tothe implant analog, the contour being tapered downwardly toward theimplant analog; transferring to a robot (i) the implant-analogpositional information, and (ii) the emergence profile contourinformation; using the robot to modify the physical model by creating anopening in the physical model having a tapering contour; and using therobot to affix the implant analog within the opening of the physicalmodel.
 16. The method of claim 15, further including scanning thepatient's mouth to develop the three-dimensional virtual model of thepatient's mouth.
 17. The method of claim 16, further including makingthe physical model from the data derived from the scanning of thepatient's mouth.
 18. The method of claim 15, wherein the virtual modelincludes features derived from informational markers on a healingabutment that is mounted to an implant in the patients mouth.
 19. Themethod of claim 15, further including calibrating the location of aportion of the robot, through a calibration system.
 20. A method ofpositioning an implant analog in a physical model of a patient's mouthfor use in creating a custom abutment, the method comprising: scanningthe physical model to develop scan data of the physical model;transferring the scan data to a CAD program; creating athree-dimensional model of at least a portion of the physical model onthe CAD program using the scan data; determining, in thethree-dimensional model, the location of the implant analog to be placedin the physical model; and using a robot to place an implant analogwithin the physical model in accordance with information from thethree-dimensional model.